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ENG2023-0135+Application+3.9.2023_12.09.51_AM+3410431CITY OF EDMONDS MyBuildingPermit.com Utilities Application #1280195 - Koh Residence Applicant First Name Last Name Company Name Nazim Nice Motionspace Architecture + Design Number Street Apartment or Suite Number E-mail Address 3104 Western Avenue #107 nazim(@_motion-space.com City State Zip Phone Number Extension Seattle WA 98121 (206) 204-0490 Contractor Company Name Contractor Unknown Number Street City State License Number Project Location State Zip License Expiration Date UBI # Number Street 15604 75TH PL W City Zip Code EDMONDS 98026 Associated Building Permit Number PRE2022-0010 Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name County Parcel Number 00513100002410 Tenant Name Last Name or Company Name HARTANAH KL LLC Apartment or Suite Number Phone Number Extension E-mail Address Floor Number Suite or Room Number Number Street Apartment or Suite Number 15324 MERIDIAN DR SE City State Zip LYNNWOOD WA 98087 Certification Statement - The applicant states: certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work requires a licensed contractor to perform the work, the information will be provided prior to permit issuance. Date Submitted: 3/9/2023 Submitted By: Nazim Nice Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Utilities Application #1280195 - Koh Residence Project Contact Company Name: Motionspace Architecture + Design Name: Jack Bader Email: jack@motion-space.com Address: 3104 Western Avenue #107 Phone #: (206) 495-5847 Seattle WA 98121 Project Type Activity Type Scope of Work Single Family Residential Utility Availability Sanitary Sewer Main Project Name: Koh Residence Description of Work: New 3000 SF, one story, single family residence with attached garage Project Details Structure Type Single Family Dwelling Project Information Connection to City sewer service Page 2 of 2